The New Zealand Centre for Cognitive Behaviour Therapy
   REGISTRATION / PURCHASE FORM
    for Professional Training Resources
   

   Please follow the numbered instructions & complete form legibly

   1     Ensure you have read the refund policy.
   2     Tick the box(es) to register for an event or purchase an item:
     
                                                              (Goods & Services tax at 15% is already included in all items)     Cost (NZ$):
 □ Online course: Primary Certificate in Rational Emotive Behaviour Therapy                                     655.00
 □ Software: Rational Analysis Training Simulator (current Certificate Holders only)                             45.00
                                 
 
   3     Complete details about yourself:   ▼ 
 
  NB: all sections below must be completed (put 'none' where applicable - contact the Centre if unsure)
 

Name:

Phone (show STD)  Day:                                                Evening:                                             Fax:

E-mail:

Postal Address:

Profession:


 
Professional Association:

Current position:

Qualifications:

 

How I heard about these programs:

Invoice for payment to be made out to:  
□ Myself (to address above)
□ Other (details here) →

Signed:                                                         Date:

 

  4   Send completed form to the Centre: (NB: do not send any money at this stage)

          Post: PO Box 2292, Stortford Lodge, Hastings, New Zealand 4153    
          Fax: 64-6-870 9964                           E-mail: training@rational.org.nz

 

Go to: HOME page / main TRAINING page           NB: Information on this page is subject to change without notice.